Provider Demographics
NPI:1063554004
Name:ROBESON HEALTH CARE CORPORATION
Entity type:Organization
Organization Name:ROBESON HEALTH CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BEHAVIORAL HEALTH SVCS
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV
Authorized Official - Phone:910-521-2900
Mailing Address - Street 1:60 COMMERCE PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7386
Mailing Address - Country:US
Mailing Address - Phone:910-521-2900
Mailing Address - Fax:910-775-9165
Practice Address - Street 1:309 EAST WARDELL DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7998
Practice Address - Country:US
Practice Address - Phone:910-521-1464
Practice Address - Fax:910-521-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-078-062101YA0400X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005789Medicaid
NC8300812BMedicaid
NC8300812Medicaid
NC8300812GMedicaid
NC8300812PMedicaid
NC8300812QMedicaid